Trauma Therapy 2009 Thesis Abstract & Summary

Much has been written about evidence-based treatments for Post traumatic Stress Disorder(PTSD). A number of treatment guides have been written (e.g. AMCPH, 2007; Briere 2006; Foa Keane,& Friedman, 2000;). Medicare criteria based on empirical research and outcome measures stipulate which treatments and practitioner qualifications will be funded. However, little is known about the relationship between these guidelines and what clinicians actually utilize in trauma treatment and use as indicators of good outcomes. The research studies compromise external validity by excluding the majority of typical PTSD clientele, necessitating exploration of treatment effectiveness in diverse real-life populations (Spinazzola, Blaustein, & van der Kolk, 2005). This qualitative study explored how trauma practitioners defined good outcomes and their experiences of how these are achieved effectively. Trauma counsellors (n=22) participated in one of five focus groups. The thematic analysis undertaken within a phenomenological theoretical framework showed the importance of therapeutic process and relationship. Trauma clients’ needs of safety, trust, empowerment, therapeutic window coupled with their degree of resilience were emphasized. Findings provide important information to policy makers, trauma practitioners and research about effective practice by describing both positive and negative outcomes. The direct and indirect implications of managed care systems such as Medicare are elucidated.

Summary

Although the topics explored a link between techniques and outcomes, practitioners emphasised how the work with traumatised clients focuses on therapeutic process and relationships. Practitioners clearly elucidated the needs of clients and therapist. Trauma client needs were prioritised as a need for trust, safety, empowerment, and establishment of a therapeutic window whilst working within the client’s resilience capacity. Practitioners need:PTSD knowledge for ongoing clinical judgement; personal therapy and supervision; and flexibility in adapting therapy to environmental constraints.

Outcome measurements and dimension descriptions surpassed simplistic symptom measurement. Outcomes were described as complicated, layered, multiple processes (e.g.,relationships, existentialism and self-identity) sometimes taking years to show up. There was a spectrum of what could be expected, depending on multiple factors (e.g., client’s resilience,social supports, trauma history, or length of therapy). Outcomes reflected client perceptions of improvement, plus practitioner observations of clients’ capacity (i.e., additional supportive relationships) to progress in the broader life context, without therapy. This capacity indicated to practitioners that empowerment, thus recovery had been achieved.

Conclusions

The most striking aspect of the data was the emphasis on therapeutic process and long-term relationship rather than techniques, which overturned the original premise that there must be some techniques which result in better outcomes. An old adage has been modified by the data in the following way: “It is [both] what you know [and] how much you care”. Glassgold’s (2007) description of liberation psychology based upon existentialism, sums up some of the philosophy manifested in the current study participants’ discourse: constantly create flexibility to allow for constant change, empower agency, activism and avoid being part of an oppressive, labelling system. The current therapists emphasised flexibly empowering clients by sharing appropriate knowledge and understanding in a supportive long-term relationship and follow the client’s needs. This demands that research focus on process and relationship analysis.